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GLOBAL AIDS
U P D AT E
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U N A I DS | 2 016

DATE
2016
 E NO R MO U S GA IN S, P E RSISTENT C HALLENGES

The world has committed to ending the AIDS epidemic by 2030. How to reach
this bold target within the Sustainable Development Goals is the central question
facing the United Nations General Assembly High-Level Meeting on Ending
AIDS, to be held from 8 to 10 June 2016. The extraordinary accomplishments of
the last 15 years have inspired global confidence that this target can be achieved.

UNAIDS recommends a Fast-Track approach: substantially increasing and front-

loading investment over the next five years to accelerate scale-up and establish
the momentum required to overcome within 15 years one of the greatest public
health challenges in this generation.

The latest UNAIDS data, covering 160 countries, demonstrate both the enormous
gains already made and what can be achieved in the coming years through a
Fast-Track approach. In just the last two years the number of people living with
HIV on antiretroviral therapy has increased by about a third, reaching 17.0 million
people—2 million more than the 15 million by 2015 target set by the United
Nations General Assembly in 2011. Since the first global treatment target was set
in 2003, annual AIDS-related deaths have decreased by 43%. In the world’s most
affected region, eastern and southern Africa, the number of people on treatment
has more than doubled since 2010, reaching nearly 10.3 million people. AIDS-
related deaths in the region have decreased by 36% since 2010.

However, huge challenges lie ahead. In 2015 there were 2.1 million
[1.8 million–2.4 million] new HIV infections worldwide, adding up to a total of
36.7 million [34.0 million–39.8 million] people living with HIV.

Number of people living with HIV on antiretroviral therapy, global, 2010–2015

17.0
18 million
15.0
16 2015 target within the 2011 million
People on antiretroviral therpay (million)

United Nations Political 12.9

14 Declaration on HIV and AIDS million
10.9
12 million
9.1
10 7.5 million
million
8

2010 2011 2012 2013 2014 2015

Sources: Global AIDS Response Progress Reporting (GARPR) 2016; UNAIDS 2016 estimates.

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HIV epidemic and response estimates, global and by region, 2010 and 2015

People living with HIV (all ages) New HIV infections (all ages)

2010 2015 2010 2015

33.3 million 36.7 million 2.2 million 2.1 million

Global
[30.9 million–36.1 million] [34.0 million–39.8 million] [2.0 million–2.5 million] [1.8 million–2.4 million]

4.7 million 5.1 million 310 000 300 000

Asia and Pacific
[4.1 million–5.5 million] [4.4 million–5.9 million] [270 000–360 000] [240 000–380 000]

17.2 million 19.0 million 1.1 million 960 000

Eastern and southern Africa
[16.1 million–18.5 million] [17.7 million–20.5 million] [1.0 million–1.2 million] [830 000–1.1 million]

Eastern Europe 1.0 million 1.5 million 120 000 190 000
and central Asia [950 000–1.1 million] [1.4 million–1.7 million] [110 000–130 000] [170 000–200 000]

1.8 million 2.0 million 100 000 100 000

Latin America and the Caribbean
[1.5 million–2.1 million] [1.7 million–2.3 million] 86 000–120 000] [86 000–120 000]

190 000 230 000 20 000 21 000

Middle East and North Africa
[150 000–240 000] [160 000–330 000] [15 000–29 000] [12 000–37 000]

6.3 million 6.5 million 450 000 410 000

Western and central Africa
[5.2 million–7.7 million] [5.3 million–7.8 million] [350 000–560 000] [310 000–530 000]

Western and central Europe and 2.1 million 2.4 million 92 000 91 000
North America [1.9 million–2.3 million] [2.2 million–2.7 million] [89 000–97 000] [89 000–97 000]

People living with HIV on antiretroviral treatment (all ages) AIDS-related deaths (all ages)

2010 2015* 2010 2015

1.5 million 1.1 million

Global 7 501 100 17 025 900
[1.3 million–1.7 million] [940 000–1.3 million]

240 000 180 000

Asia and Pacific 907 600 2 071 900
[200 000–270 000] [150 000–220 000]

760 000 470 000

Eastern and southern Africa 4 087 500 10 252 400
[670 000–860 000] [390 000–560 000]

Eastern Europe 38 000 47 000

112 100 321 800
and central Asia [33 000–45 000] [39 000–55 000]

60 000 50 000
Latin America and the Caribbean 568 400 1 091 900
[51 000–70 000] [41 000–59 000]

9500 12 000
Middle East and North Africa 13 600 38 200
[7400–12 000] [8700–16 000]

370 000 330 000

Western and central Africa 905 700 1 830 700
[290 000–470 000] [250 000–430 000]

Western and central Europe and 29 000 22 000

906 200 1 418 900
North America [27 000–31 000] [20 000–24 000]

* Difference in global and regional sums due to rounding.

Sources: GARPR 2016; UNAIDS 2016 estimates.

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 E X PA NSI ON OF LIFE -SAV IN G
TR E ATM E N T

Scale-up of antiretroviral therapy is on a Fast-Track trajectory that has

surpassed expectations. Global coverage of antiretroviral therapy reached 46%
[43–50%] at the end of 2015. Gains were greatest in the world’s most affected
region, eastern and southern Africa. Coverage increased from 24% [22–26%] in
2010 to 54% [50–58%] in 2015, reaching a regional total of 10.3 million people.

South Africa alone had nearly 3.4 million people on treatment, more than any
other country in the world. After South Africa, Kenya has the largest treatment
programme in Africa, with nearly 900 000 people on treatment at the end of
2015. Botswana, Eritrea, Kenya, Malawi, Mozambique, Rwanda, South Africa,
Swaziland, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe
all increased treatment coverage by more than 25 percentage points between
2010 and 2015.

Antiretroviral therapy coverage among people living with HIV, by region, 2010–2015

70 2010
2011
2012
2013
60 2014
2015

50
Antiretroviral therapy coverage (%)

40

30

20

10

Middle East Eastern Europe Western Asia and Pacific Eastern Latin America and Western and
and North Africa and central Asia and central Africa and southern the Caribbean central Europe and
Africa North America

Sources: GARPR 2016; UNAIDS 2016 estimates.

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Distribution of antiretroviral therapy, by country, 2015

Rest of the world

South Africa

India

25 other Fast-Track countries* Kenya

Zimbabwe

United States Uganda

United Republic of America
of Tanzania Nigeria
Zambia Mozambique

* The Fast-Track countries include the 10 displayed on this chart, plus Angola, Botswana, Brazil, Cameroon, Chad, China, Côte d’Ivoire, Democratic Republic of
the Congo, Ethiopia, Ghana, Haiti, Indonesia, Iran (Islamic Republic of), Jamaica, Lesotho, Malawi, Mali, Myanmar, Namibia, Pakistan, South Sudan, Swaziland,
Russian Federation, Ukraine and Viet Nam.

Sources: GARPR 2016; UNAIDS 2016 estimates.

Treatment coverage in Latin American and the Caribbean reached 55% [47–64%]
in 2015. In the Asia and Pacific region, coverage more than doubled, from 19%
[17–22%] in 2010 to 41% [35–47%] in 2015. Western and central Africa and the
Middle East and North Africa also made important gains but achieved lower levels of
coverage in 2015, 28% [23–34%] and 17% [12–24%], respectively. In eastern Europe
and central Asia, coverage increased by just a few percentage points in recent years
to 21% [20–23%]—about one in five people living with HIV in the region.

The gains in treatment are largely responsible for a 26% decline in AIDS-related
deaths globally since 2010, from an estimated 1.5 million [1.3 million–1.7 million] in
2010 to 1.1 million [940 000 –1.3 million] in 2015.

The reduction in deaths since 2010 has been greater among adult women (33%
decrease) compared with adult men (15% decrease), reflecting higher treatment
coverage among women than men, 52% [48–57%] and 41% [33–49%], respectively.

The gender gap for treatment among adults highlights the impact of gender norms
that delay initiation of treatment among men, reduce treatment adherence, blunt the
preventive effects of treatment, and lead to men accounting for 58% of adult AIDS-
related deaths.

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 Antiretroviral therapy coverage and number of AIDS-related deaths, global, 2000–2015

60 3

50

Number of AIDS-related deaths (million)

Antiretroviral therapy coverage (%)

40 2

30

20 1

10

0
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

HIV treatment coverage (all ages) AIDS-related deaths (all ages)

Sources: GARPR 2016; UNAIDS 2016 estimates.

The Fast-Track approach to HIV treatment is working. Global consensus and

leadership have driven greater investment of financial and human capital, and
mounting clinical experience and research, improved treatment regimens
and diagnostics and reductions in the price of medicines have created gains
in efficiency and effectiveness. The continuing momentum reinforces the
determination to achieve the 90–90–90 treatment target by 2020, whereby 90%
of people living with HIV know their HIV status, 90% of people who know their
HIV-positive status are accessing treatment and 90% of people on treatment have
suppressed viral loads.

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 R E I N VI G O RATION OF H IV P REVENT IO N
N E E D E D T O Q U ICKE N THE DEC LINE IN
A DU LT I NFE CTION S

Declines in new HIV infections among adults have slowed alarmingly in recent years,
with the estimated annual number of new infections among adults remaining nearly
static at about 1.9 million [1.7 million–2.2 million] in 2015. Beneath this global figure
lie multiple disparities—across regions, within countries, between men and women
and young and old, and among specific populations being left behind. These
disparities must be addressed in order to achieve the reductions required to end the
AIDS epidemic as a public health threat by 2030.

Regional disparities

The largest reduction in new adult HIV infections occurred in eastern and southern
Africa. There were about 40 000 fewer new adult HIV infections in the region in 2015
than in 2010, a 4% decline. More gradual declines were achieved in the Asia and
Pacific region and western and central Africa. Rates of new adult HIV infections were
relatively static in Latin America and the Caribbean, western and central Europe,
North America and the Middle East and North Africa, while the annual numbers of
new HIV infections in eastern Europe and central Asia increased by 57%.

New HIV infections among people aged 15 years and over, by region, 2010–2015

1200 250
New HIV infections among people aged 15 years and over

New HIV infections among people aged 15 years and over

1000
200

800
150
(thousand)

(thousand)

600

100
400

50
200

0 0

2010 2011 2012 2013 2014 2015 2010 2011 2012 2013 2014 2015

Eastern and southern Africa Eastern Europe and central Asia

Western and central Africa Latin America and the Caribbean
Asia and Pacific Western and central Europe and North America
Middle East and North Africa

Source: UNAIDS 2016 estimates.

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 Key locations within countries
Complex and varied social, structural and economic dynamics within countries
account for the uneven geographical distribution of HIV. In many countries, HIV
prevalence is higher in cities, where the vibrancy, stress and anonymity of urban
life, and its bustle of encounters and interactions, provide increased opportunities
for behaviours and sexual networking that may increase the risk of HIV infection.
Increased efforts to collect and analyse subnational data are revealing where HIV
infections are occurring and where there are gaps in the provision of HIV services.
In Kenya, for example, an analysis in 2014 found that 65% of new HIV infections
occurred in just 9 of the country’s 47 counties (1). This analysis contributed to a
national HIV prevention “road map” that defines evidence-informed biomedical
and structural interventions and targets them to specific populations and
geographical zones. The Kenya AIDS Strategic Framework aims to reduce annual
new HIV infections among adults by 75% by 2019.

Estimated new HIV infections by county, Kenya, 2014

Sources: UNAIDS 2015 estimates; Kenya Ministry of Health.

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 Advancing the agenda of adolescent girls and young women

Adolescent girls and young women aged 15–24 years are at particularly high risk of
HIV infection, accounting for 20% of new HIV infections among adults globally in 2015,
despite accounting for just 11% of the adult population. In geographical areas with
higher HIV prevalence, the gender imbalance is more pronounced. In sub-Saharan
Africa, adolescent girls and young women accounted for 25% of new HIV infections
among adults, and women accounted for 56% of new HIV infections among adults.
Harmful gender norms and inequalities, insufficient access to education and sexual and
reproductive health services, poverty, food insecurity and violence, are at the root of
the increased HIV risk of young women and adolescent girls.

Distribution of new adult HIV infections and population by age and sex, global
and in sub-Saharan Africa, 2015

NEW HIV INFECTIONS AMONG ADULTS, BY ADULT POPULATION, BY AGE AND SEX,
AGE AND SEX, GLOBAL, 2015 GLOBAL , 2015

27%
25+
39% 39%
years old
39% 25+ 25+
years old years old
25+
years old
20%
15–24 11% 11%
years old 14%
15–24 15–24
15–24 years old years old
years old

NEW HIV INFECTIONS AMONG ADULTS, BY ADULT POPULATION, BY AGE AND SEX,
AGE AND SEX, SUB-SAHARAN AFRICA, 2015 SUB-SAHARAN AFRICA, 2015

31% 31%
25+ 25+ 33% 32%
years old years old 25+ 25+
years old years old

12%
25% 17% 17%
15–24
15–24 15–24 15–24
years old
years old years old years old

Source: UNAIDS 2016 estimates.

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 Key populations are being left behind

Key populations at increased risk of HIV infection include sex workers, people who
inject drugs, transgender people, prisoners and gay men and other men who have
sex with men. Reinvigorating HIV prevention requires additional focus on providing
key populations with tools such as condoms, pre-exposure prophylaxis and sterile
needles and syringes. However, the design and delivery of HIV prevention services
are limited by a reluctance to reach out to key populations. In many countries, they

Distribution of new HIV infections among population groups, by region, 2014

5% 4% 6%

13%
15%
0.4%
EASTERN WESTERN 2%
38% ASIA AND 33%
18% EUROPE AND AND CENTRAL
PACIFIC
CENTRAL ASIA AFRICA 10%
51%

2% 73%
6%
24%

2%

6% 4% 4%
2% 9%
6%

9%

36% LATIN
MIDDLE EAST EASTERN AND
AMERICA 30% 41% 28%
AND NORTH SOUTHERN
AND THE
AFRICA AFRICA
CARIBBEAN
79%
3%
23% 18%

7% 1%
15%

Sex workers
WESTERN
28% AND People who inject drugs
CENTRAL Gay men and other men who have sex with men
EUROPE,
NORTH Transgender people
AMERICA
Clients of sex workers and other sexual partners of key populations
49%
Rest of population

Source: UNAIDS special analysis, 2016.

Methodological note: Estimated numbers of new HIV infections by key population were compiled from country Spectrum files submitted in 2015 to UNAIDS
(2014 data), available modes-of-transmission studies and additional sources of data drawn from GARPR reports. Where data were lacking, regional medians were
calculated from available data and applied to countries’ populations.

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 are pushed to the fringes of society by stigma and the criminalization of same-sex
relationships, drug use and, sex work. This marginalization limits their access to HIV
services.
Analysis of data available to UNAIDS suggests that more than 90% of new HIV
infections in central Asia, Europe, North America, the Middle East and North Africa in
2014 were among people from key populations and their sexual partners. In the Asia
and Pacific region, Latin America and the Caribbean, people from key populations
and their sexual partners accounted for nearly two thirds of new infections. In sub-
Saharan Africa, key populations accounted for more than 20% of new infections, and
HIV prevalence among these populations is often extremely high. For example, in
South Africa, surveillance data published in 2015 estimated HIV prevalence among sex
workers was 71.8% in Johannesburg, 39.7% in Cape Town and 53.5% in Durban (2).
These data also show that the distribution of new HIV infections among key
populations varies by region. People who inject drugs accounted for 51% of HIV
infections in eastern Europe and central Asia and 13% of new HIV infections in Asia and
the Pacific in 2014. Gay men and other men who have sex with men accounted for 30%
of new HIV infections in Latin America, 49% of new infections in western and central
Europe and North America and 18% of new infections in Asia and the Pacific. This
underscores the urgent need to ensure that key populations are fully included in AIDS
responses and services are made available to them. Data show that when services
are made available within an environment free of stigma and discrimination, new HIV
infections have declined significantly.

Z E R O DI SCRIM IN ATION

Ignorance and misunderstanding continue to undermine efforts to end AIDS. In

the worst cases, discriminatory attitudes and behaviour are facilitated by punitive
laws and policies. In 2016, 72 countries had laws allowing specifically for HIV
criminalization (3). Between 1 April 2013 and 30 September 2015, four countries in
sub-Saharan Africa passed new HIV criminalization laws: Botswana, Côte d’Ivoire,
Nigeria and Uganda (3).

Data from population-based surveys suggest that discriminatory attitudes towards

people living with HIV have declined slowly, but progress has been uneven across
countries and between women and men (4). In approximately half of countries with
available data between 2009 and 2014, over 50% of women and men aged 15–49 years
reported they would not buy vegetables from a shopkeeper living with HIV (4).

The People Living with HIV Stigma Index measures stigma and discrimination reported
by people living with HIV. Stigma Index surveys have been conducted in more than 65
countries. In 22 of these countries, more than 10% of people living with HIV reported
they had been denied health care, and more than 1 in 10 people living with HIV

10
 reported they had been refused employment or a work opportunity because of their
HIV status in the 12 months before the survey (5). In 30 countries where surveys were
conducted, 1 in 10 people living with HIV reported they had lost a job or another
source of income because of their HIV status (5).1

E NDI N G A IDS RE Q U IRE S GLO BAL CO MMIT MENT

TO B O L D TA RGE TS FOR 2 0 2 0

The progress made in reaching people with HIV treatment and in reducing AIDS-
related deaths demonstrates the effectiveness of a Fast-Track approach. These
AIDS-response successes show that exceptional results can be achieved when
there is broad leadership and consistent financial commitment.

The job is still only half done, however. Approximately 54% [50–57%] of people
living with HIV are in need of treatment, many of whom do not know their
HIV status. A growing number of countries have committed to achieving the
90–90–90 treatment target by 2020. This coalition of the brave needs to expand
to a global commitment, and that commitment must translate quickly into even
greater innovation and investment.

A similar foundation of vision and leadership is required to reinvigorate HIV

prevention. An array of effective HIV prevention tools is available, including
condoms, harm reduction, voluntary medical male circumcision, pre-exposure
prophylaxis, cash transfers for girls and structural approaches that promote
gender equality and access to secondary education. Community- and peer-based
approaches to sharing prevention tools are proven effective.

The key is to combine these tools into combination HIV prevention packages
that address the specific needs of populations that are being left behind, and
to establish enabling environments that allow these populations to access
HIV, health and social services without fear of violence, arrest or persecution.
Specific targets on reaching the people at greatest need of these packages are
urgently required.

The 2030 Agenda for Sustainable Development is underpinned by the concepts

of inclusion, equity and social justice. Consistently applying these concepts to
the AIDS response is critical to a Fast-Track approach. Compared with the 2014
coverage of HIV services, a comprehensive Fast-Track approach in line with the
UNAIDS 2016–2021 Strategy will avert an additional 17.6 million HIV infections
and 10.8 million AIDS-related deaths between 2016 and 2030.

An opportunity to improve the lives of so many people must not be missed.

1 Due to sampling challenges, the data from People Living with HIV Stigma Index surveys are not representative of all people living with HIV
in a country.

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 R E FE R E NCE S

1 Kenya HIV Prevention Revolution road map: count down to 2030. Nairobi: Kenya
Ministry of Health; 2014.

2 UCSF, Anova Health Institute & WRHI (2015). South African Health Monitoring
Study (SAHMS), Final Report: The Integrated Biological and Behavioural Survey
among Female Sex Workers, South Africa 2013-2014. San Francisco: UCSF.

3 Advancing HIV justice 2: building momentum in global advocacy against HIV

criminalisation. Brighton and Amsterdam: HIV Justice Network and Global
Network of People Living with HIV; 2016 (http://www.hivjustice.net/wp-content/
uploads/2016/05/AHJ2.final2_.10May2016.pdf).

4 Household surveys 2000–2014.

5 UNAIDS, Review of data from People Living with HIV Stigma Index surveys
conducted in more than 65 countries, 2016.

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